Social Justice and the 45th Street Clinic

By Abbie Drake and Mike Mouhanna

A couple of friends were down by the river and noticed a baby float by. Shocked, one quickly jumped in and swam to rescue the baby. The next day, the same friends were down by the river and were once again shocked to notice two babies floating down the river. Again, one of the friends jumped in to save the baby.

The next day, the same story – only there were four babies this time. This kept happening for almost a week, with more babies each day. Finally the friends decided they had to do something to deal with this. They organized themselves, taking turns watching over the water and rescuing the babies as they floated down the river. The friends got friends involved, and before long the whole town was helping to rescue the babies floating down the river. But the number of babies kept increasing.

Then it dawned on someone: “Where are all these babies coming from? Why don’t we form a team to go upriver and see if we can stop the flow of babies at the source?” But some resisted, saying, “If we go upstream, who will run the rescue operations? We need every concerned person here! Pastor Kevin Lum, Sojourners

Autumn Quarter 2012, students in “Pathologies of Power: Reflections on Medicine, Power, and Social Justice” formed into groups to visit community clinics. Each group focused on a contemporary theory of justice. Our group sought to understand medicine through Nancy Fraser’s work on redistribution, recognition, and participation as paths to a more just society. The Fraser group visited the 45th Street Clinic in Seattle. After spending the beginning of the University Seminar reading about medicine and medical activism, we hoped to find a real-world example of social justice.

Seeking a holistic approach

According to clinic manager Michelle Raymond, 40 years ago, local community-health advocates transformed what was once a fire station into a free women’s clinic. Over time the women’s clinic expanded into a facility interested in a more holistic approach to community health care. Raymond described it as “a freestanding, low-cost care clinic with the mission of 0 percent disparity and 100 percent access.” She shared her own version of rescuing babies from the river to rescuing the health of those in poverty.

During our time at the clinic, we began to see that socioeconomic differences are the source of “the babies floating down the river.” And Raymond felt it was important to make a distinction between charity and justice. Charity, she explained, is caring for the patients (rescuing the babies); justice is finding the source of their poverty and changing it.

Empowering patients

At the 45th Street Clinic, health care providers are responsible for the care of patients, yet they acknowledge the need for social justice through the activities of the political action committee. This committee seeks to keep their patients and community members informed about legislation. Clinic leaders hope that providing information for their community will empower patients to participate in, and transform, the political system in order to decrease inequities in the health area. The clinic even alerts patients of petitions and provides contact information for government officials to raises awareness for how to change the community.

The 45th Street Clinic is a part of Neighborcare Health, a system of clinics that provides low-cost care for people in the Seattle area. Federal funding, along with donations, allows for the use of a sliding-fee scale, making it possible for the clinic to treat patients who may not be able to afford treatment elsewhere.

According to Neighborcare Health’s 2011 Report to the Community, 69 percent of their patients live at or below the poverty level. Without the clinic’s sliding-fee scale, these people could not afford health care ― and the policy of Neighborcare Health is to treat anyone from “cradle to grave.”

Meeting the health care needs of the neighborhood

Clinics like Neighborcare meet the financial needs of people with low incomes. (Their health would be in even worse condition without these programs and efforts to educate their communities.) Health insurance is expensive and the low-income citizens often cannot afford it. We argue that health care is a right that all citizens should have, and the clinic’s charity ensures justice by protecting this right. This clinic’s motto of nondiscrimination by helping anyone in need should serve as an example for every health care service. These clinics do not solve the root problem, but they do help to put a damper on the effects of poverty.

"Misrecognition"

The staff accommodate more than the financial needs of their patients. The Neighborcare clinics meet the needs of ethnic minority groups. However, at the poverty level, the majority of the clinic’s patients, these ethnic groups no longer are minorities.

These groups tend to suffer from what social justice theorist Nancy Fraser calls “misrecognition,” which refers to injustice caused by society not recognizing a group’s beauty, humanity, and norms. Misrecognition leads to a deformed community image and unequal treatment in the public sphere. One frequent misrecognition of ethnic groups is their spoken language. Only 32 percent of the patients are white/Caucasian, and while English is the primarily spoken language, the clinic commonly encounters 19 other languages. The clinic employs staff fluent in all of these languages to effectively communicate with all of their patients. This extra effort shows the dedication of the staff to overcome the injustice of misrecognition.

Low-cost clinics require low overhead costs to compensate for lower patient fees, but this does not affect the quality of the staff. Physicians at the 45th Street Clinic are capable of working in areas in the health care system that would allow them to make a substantially greater income. According to Raymond, the doctors we meet during our visit were just as proficient and dedicated to their jobs as wealthier clinicians. Based on our visit, we surmised their motives are charity, not a high salary.

Community health is a complex issue, and the 45th Street Clinic goes beyond medical care. They realize that health is more than a medical problem and that community health means providing resources, knowledge, and opportunities for community involvement.

To that end, the clinic provides a place for youth to spend their Wednesday and Thursday nights. In fact, the 45th St. Clinic has done such an amazing job that they were gifted a special patient access grant, which amounts to half a million dollars. The money will go to a remodel of their facility so that they can keep doing what they are doing to provide “0 percent disparity with 100 percent access.”

Reflecting on our experience, Fraser group members realized that our eyes had been opened to a new understanding of justice as a result of the readings and discussions in “Pathologies of Power: Reflections on Medicine, Power and Social Justice.” We’d all heard the term “social justice,” and we’ve almost become numb to it. This clinic visit, however, provided a new perspective on social justice. Our learning went beyond mere classroom knowledge and theories.

During our post-visit meeting, we also realized how much we have learned about social justice. For example, when listening to Raymond discuss the work of the clinic, we were familiar with her use of justice language. More specifically, our reading of Nancy Fraser allowed us to recognize the aspect of misrecognition in the demographics of the clinic, the redistribution of their “sliding-fee scale” and how the clinic promotes political activism to ensure a parity of participation for its patients. Our real-world encounter at the clinic made what we'd learned in class a reality.

Abbie Drake (right) is a freshman at Seattle Pacific University and plans to major in visual communications. Her aim is to work in graphic design or advertising.

Michael Mouhanna is also an SPU freshman, and he intends to major in accounting. He plans to become an accountant after college.